Evaluation of the diagnostic performance of 18F-NaF positron emission tomography/computed tomography in patients with suspected ankylosing spondylitis according to the Assessment of SpondyloArthritis International Society criteria

BACKGROUND CONTEXT Positron emission tomography (PET) is a potential imaging technique for the diagnosis of AS. The visualization of physiological change makes PET potentially suitable for early detection of inflammatory processes, even before anatomical changes occur. Thus, PET might provide specificity via the use of receptor targeting tracers and allows quantification of disease activity in order to accurately monitor therapeutic effects. PURPOSE To examine fluorine-18 sodium fluoride (18F-NaF) PET/computed tomography (PET/CT) findings in patients with inflammatory low back pain and evaluate the utility of this modality in the diagnosis of ankylosing spondylitis (AS) according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. STUDY DESIGN Retrospective cohort study. PATIENTS SAMPLE Sixty-eight patients who underwent 18F-NaF PET/CT imaging between April 2015 and April 2017 for evaluation of inflammatory low back pain. OUTCOME MEASURES We defined AS-positive lesions on PET/CT as symmetric sacroiliac joint uptake that suggests sacroiliitis, syndesmophytes on the spine, and enthesopathy at any site. METHODS All patients were evaluated using the ASAS criteria and assigned to either the AS or the control group. The diagnostic criteria of AS on PET/CT images were defined as 18F-NaF PET/CT images with at least one of AS-positive findings. RESULTS The diagnostic rate of AS was 72.1% among the 68 patients according to the ASAS criteria. The baseline characteristics between the two groups differed significantly in terms of serum C-reactive protein levels and the presence of human leucocyte antigen-B27. Compared to the control group, in the AS group, 39 patients (79.5%) exhibited typical 18F-NaF PET/CT-positive findings, such as enthesopathy (65.3%, p=.003), syndesmophytes (61.2%, p=.006) and symmetric sacroiliitis (67.3%, p=.001). PET-positive findings had significantly higher area under the curve values than did single 18F-NaF PET/CT- positive findings, and they had the best performance for concordant diagnosis according to the ASAS criteria. CONCLUSIONS 18F-NaF PET/CT yielded significantly different findings between the two groups according to the ASAS criteria and is useful for diagnosing AS.